A Dose of Hope: A Story of MDMA-Assisted Psychotherapy

By Dan Engle

MDMA-assisted therapy for PTSD is in the final stages of FDA testing. Clinical trials are reporting a 70 percent cure rate for a condition that claims thousands of lives globally every day—hundreds in the US alone.

But until it's fully legalized, MDMA is still a Schedule I drug, saddled with years of misunderstanding, misinformation, and misuse.

In this groundbreaking, informative, and easy-to-read book, Dr. Dan Engle shows you the treatment through the eyes of a fictional patient so you can see how it works without ever setting foot in a doctor's office.

Follow in-depth conversations between doctor and patient, learn about the history of MDMA-assisted therapy, understand how and why it helps, and experience the process for yourself—without ever having to take anything.

The treatment presented here is a synthesis of the real experiences and stunning results happening today in trials around the world. Whether you or a loved one suffer from PTSD, or you just want to heal something that's keeping you from living your best life, don't miss A Dose of Hope.

• Language: English
• Publisher: BookBaby
• Release date: Jul 20, 2021
• ISBN: 9781544521015

Dan Engle

Dr. Dan Engle is board certified in psychiatry and neurology. Dr. Engle runs a clinical practice that combines functional medicine, integrative psychiatry, neuro-cognitive restoration, and peak performance methods. He lectures and consults globally and is the medical director of The Revive Treatment Centers of America, as well as medical advisor to several treatment centers that use natural, technological, and medicinal approaches to cognitive healing and recovery. He is a leading expert on cognitive repair. His first book, The Concussion Repair Manual published in October 2017, received praise from countless figures in the medical arena. His other programs include B.O.L.D., Freedom From Meds, and Full Spectrum Medicine.

Book preview

Introduction

In the United States, during the time it takes you to finish this book, approximately 125 people will take their own lives.

The mental health crisis plaguing our culture today does not stop with suicide. The epidemics of depression, anxiety, PTSD, addiction, and chronic pain are simply expressions of a psychiatric system that is largely devoid of effective methods to deal with the deeper issues underlying the symptoms.

Namely, these underlying issues are core emotional wounds, unmet needs of the psyche, isolation or disconnection from one another, a lack of faith in something greater than one’s own self, nervous systems stuck in fight or flight, and the empty promises of material success, to just name a few.

This is not to imply the current psychiatric field is wrong—it’s just incomplete. Current pharmaceuticals have their place when symptoms are severe and need to be relieved. However, they should only be instituted while still looking at the deeper causative factors and working to resolve them.

We have another tool that can greatly help alleviate so much suffering that our current system does not address. And in the specific case of chronic, severe PTSD, the data is incontrovertible—this tool works.

That tool, broadly speaking, is MDMA-assisted psychotherapy.

PTSD stands for Post-Traumatic Stress Disorder. In its classic and severe form, it has been known in the field of combat experience as shell shock and concentration camp syndrome, and this stems from catastrophic exposure to life-threatening events. Today, that relatively limited definition has been expanded to include a wider demographic of people who have experienced a more varied trauma history, where their significant symptoms have still left them severely compromised.

When it comes to treating chronic, severe PTSD, the current standard of care model (psychotherapy and medication management) has a roughly 35 percent improvement rate.1

Compare this to chronic, severe PTSD treated with MDMA-assisted psychotherapy. It has roughly a 70 percent cure rate (cure here is defined as the patient no longer meeting the criteria for PTSD).2

At face value, that sounds pretty good as it appears to double the benefit rate. Except it’s better than that. MDMA-assisted psychotherapy is orders of magnitude better.

A mild to moderate improvement is better than nothing to be sure, but it still means the symptoms are present, and they are negatively impacting the person’s life in a significant way. The key is the difference between improvement and cure.

A cure in this context means a person no longer has symptoms meeting the criteria for even having PTSD at all. So we are roughly going from a 35% improvement rate to a 70% cure rate.

This is not a small change. This is as big as it gets in the field of mental health.

No other tool known to the world today has as much potency and potential to help people heal trauma—and instigate change in their lives—than MDMA-assisted psychotherapy.

Sound promising? It is. Hugely.

That is what this book is about.

It is intended to offer you information on one of the most powerful mind-healing agents on the planet right now.

As of the writing of this intro, MDMA is not legal to use in therapy outside of carefully run, very small clinical trials. Thankfully though, MDMA therapy is steadily working its way through the very last stage of the DEA’s federal requirement process to become a legally available treatment for people throughout the nation. As it looks now, we are on track for a greater expansion roll out increase by the end of 2021 and through 2022 to meet the demand of the people.

It’s an incredible time for the field of mental health and wellness. We’ve never been this close to delivering such powerful healing agents to the masses, and I couldn’t be more excited.

I’m so inspired, in fact, that I have dedicated my life to being part of the process that helps medicines like MDMA become widely available and better understood.

Yes, I want to do this for the obvious reason: it will help a lot of people.

But there’s more to it for me—a set of more personal reasons.

I struggled with severe depression and, at one time, contemplated taking my own life. It was a medicine similar to MDMA that helped me get unstuck and pulled me out of that state.

My sister Trudy was not so lucky. In 2013, she committed suicide.

This is the major impetus for me to co-write this book.

Like many family members of suicide, I’m not even sure how to write about it. To do it full justice and tell the whole story would require volumes. Here are the highlights of it:

She’s eight years older than me (it still feels demeaning and strange to write about her in the past tense) and my half-sister. We share the same father and were raised in separate households. Even though we saw each other less than if we had grown up down the hallway, we still felt the deep, soul-level connection of siblings that exists across space and time.

As a child, she was witty, feisty, rebellious, and sincere. As an adult, she was deep, powerful, passionate, and brooding. She was first and foremost a poet and poured her heart out through her writing. This is one of my favorite poems of hers:

Masks

the wind silently

calls for me

urging me

to go on,

it picks me up

and carries me

to the place

where I belong.

and when I remove

this false disguise

only you my friend

will see,

the person you have

known so long

is in fact—

not even me…

Years later, during my studies in psychiatric medicine, she revealed to me the source of her poetry and her pain: repeated sexual abuse as a child.

While being raised in her mother’s household, she was serially molested by an uncle. This occurred frequently and regularly from her elementary school years into middle school.

Like so many victims of child abuse, she was consumed by shame and guilt and, thus, hid this truth. Nobody on our father’s side knew back then. We’re not sure if anyone knew what was going on outside of Trudy and her abuser.

She used alcohol to help numb the pain. And poetry. Poetry helped give it a voice. And to relieve it.

She did all the right things in the standard medical treatment: mountains of psychotherapy, a litany of antidepressants, and biweekly AA meetings. She was committed to living fully, went to church faithfully, and helped others whole-heartedly.

Then, one night, after fourteen months of sobriety, with a bottle of wine and a gun—and no warning signs—she ended her life.

We still don’t know why and may never uncover the reason. She must have been suffering heroically for a long time and the inescapable pain finally overtook her.

Addiction was not the problem. Addiction was her strategy to cope with her trauma.

Most people can’t comprehend the magnitude of suffering required to actually take one’s own life. You have to live it to know it. It’s an abyss that can feel impossible to get out of.

This was a lightning strike for me. It was my call to action.

This is why it’s my mission to educate, advocate, and facilitate the implementation of psychedelic therapies, beginning with MDMA-assisted psychotherapy, into the medical mainstream.

This book is the latest installment in service to this mission, and it was written to help you, the layperson, become educated on this therapy.

This book also exists because of how well MDMA therapy helped a friend of mine. Over many years, I’ve supported and facilitated a number of people in their journey to become educated and experienced in MDMA-assisted psychotherapy. One of those people is a famous novelist. She had a series of sessions that helped her systematically reconcile her underlying trauma, and through this profoundly positive change, she felt deeply called to give back and help others find their healing.

She came to me with an idea for a book. She envisioned a story about a regular guy who gets called to MDMA-assisted psychotherapy. She saw the lead character not as a war veteran or a rape victim or someone who’d suffered severe and acute trauma. Although the primary research is being done on severe PTSD victims—and those people should be the first recipients of therapy—they would already be primed to receive its benefits. As she saw it, the big-picture vision was making the storyline relevant to the masses. This was especially important to her, considering that when she found this work, she didn’t think she had much trauma, if any at all. (It turns out she was quite wrong.)

Initially, I was uncertain of this approach. I’d been so focused on helping acute trauma survivors and telling Trudy’s story that I hadn’t given much consideration to telling the larger story—that trauma is not just an individual issue affecting a few unlucky people: it’s a collective one that applies to all of us.

Most everyone in our culture is living through some sort of trauma, directly or indirectly. Whether it’s through first-hand experience of it themselves, witnessing it in a loved one, receiving the transgenerational expression of trauma from their families, or via other means, trauma is all around us, and we’re all affected.

Data move science, politics move law, but it is a story that moves culture. So, I decided to work with her to help tell a story that can explain this work and move our culture further towards it, and this book is the result.

A Dose of Hope is a parable of healing that shares both the science and the personal experience of MDMA-assisted psychotherapy through the character of Alex Young.

Though this therapy is not yet broadly legal, the book takes place when it is so (likely eighteen to twenty-four months from this writing).

The character of Alex is, of course, not a real person. He’s based on both the experience of the author and interviews done with many other people who’ve gone through MDMA-assisted psychotherapy.

You meet Alex as he comes to his first appointment with me to discuss the therapy. You will learn everything he learns, as he learns it, and follow his experiences as he goes through the MDMA-assisted psychotherapy process.

Though you’ll get access to Alex’s experiences, we decided not to spend much time exploring Alex’s internal monologue, nor did we fully develop Alex’s character, as would happen in a regular novel. We’d rather you, the reader, see Alex as a stand-in for yourself (or someone you know) and we felt the best way to do that was allow space in Alex for you to project yourself into him.

The novel was written in a dialogue format for that same reason—to enable you, the reader, to put yourself into Alex’s shoes and experience as much as possible and not overburden you with too much information about him, so that you can ask yourself what the experience would be like for you.

We also decided to write this parable style, with a simple, straight-forward plot and an informational story—again, to allow you, the reader, to focus on learning about the therapy.

In short, don’t expect literary fiction. Expect to learn and feel and explore yourself.

We also took pains to ensure people would understand the intensity of the experience and how serious this is. This medicine is not a panacea or a silver bullet. It does not magically make everything go away. Rescuing someone from their own healing work is similar to robbing someone of their greatest teacher. Preparation and integration are as critical to the success of the treatment as the experience itself.

The most important goal of the book is to teach information, reveal insights, and answer key questions that a reader interested in MDMA-assisted psychotherapy might have. For example:

Why does someone decide to do MDMA-assisted psychotherapy?

What’s it actually like?

What’s integration work, and why is that important?

How does it work in practice?

What’s trauma?

Why does anyone need to care?

How do you heal from it?

The book shows how an average person would come to answer these very difficult and complicated questions.

My hope is that this book can reach those who are suffering and show them a way out.

There is always hope, and this is a story of how hope can turn into action and maybe save a life.

---

1 Bradley D. Grinage, Diagnosis and Management of Post-Traumatic Stress Disorder, American Family Physician 68, no. 12 (December 15, 2003), https://www.aafp.org/afp/2003/1215/p2401.html. Laura E. Watkins, Kelsey R. Sprang, and Barbara O. Rothbaum, Treating PTSD: A Review of Evidence-Based Psychotherapy Interventions, Frontiers in Behavioral Neuroscience (November 2, 2018), https://doi.org/10.3389/fnbeh.2018.00258. Olivia Metcalf, et al., Treatment augmentation for posttraumatic stress disorder: A systematic review, Clinical Psychology: Science and Practice 27, no. 1 (December 22, 2019), https://doi.org/10.1111/cpsp.12310.

2 Allison A. Feduccia, et al., Breakthrough for Trauma Treatment: Safety and Efficacy of MDMA-Assisted Psychotherapy Compared to Paroxetine and Sertraline, Frontiers in Psychiatry (September 12, 2019), https://doi.org/10.3389/fpsyt.2019.00650. Marcela Ot’alora G., et al., 3,4-Methylenedioxymethamphetamine-assisted psychotherapy for treatment of chronic posttraumatic stress disorder: A randomized phase 2 controlled trial, Journal of Psychopharmacology 32, no. 12 (October 29, 2018), https://doi.org/10.1177/0269881118806297. Lisa Jerome, et al., Long-term follow-up outcomes of MDMA-assisted psychotherapy for treatment of PTSD: A longitudinal pooled analysis of six phase 2 trials, Psychopharmacology 237 (August 2020), https://doi.org/10.1007/s00213-020-05548-2

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Chapter 1

1. Alex Questions Dr. Dan

The clinic was located in a gray two-story townhouse at the edge of a forest and looked like any other medical office. Flute music played in the background as I walked into the candlelit lobby, which smelled sweet and woody, like a spa, but without the humidity.

I told the receptionist my name; she said they were expecting me. I’d already filled out the primary questionnaire online, so she gave me a bottle of water and told me Dr. Dan would be ready for me soon.

I sat in the waiting room, flipped through a magazine, not really reading it, and realized something: I was nervous.

I kinda laughed because—what am I nervous about? This is just a consultation. I’m not committed to anything.

Besides, why would I be nervous about taking MDMA? I took it in college once. I know what it’s like. What’s the worst that could happen?

The receptionist told me Dr. Dan was ready and walked me back to a small office. Dr. Dan stood to greet me as I walked in. He was about 5′ 9″ and slim but in a healthy, active way. He was dressed in comfortable but stylish workout clothes, had a freshly shaved bald head, and seemed to radiate warmth and kindness. He was not dressed like any doctor I’d ever met, almost like he’d just come back from a hike.

He gave me a warm handshake, and I sat down in the chair across from him and rubbed my hands on my pants. I was even more nervous that I’d been in the waiting room, and I still didn’t understand why.

Dr. Dan: Alex, nice to meet you. I understand you’re possibly interested in MDMA-assisted psychotherapy?

Alex: Yeah, maybe.

Dr. Dan: I find that, for most people, it’s best to begin with your questions. It helps me get a clear understanding of where you are and what you expect. Does that work?

Alex: Yeah, sure.

Dr. Dan: Good. Please feel free to ask me anything. We’ll take as long as you need to get all your questions answered.

I’ve never had a doctor say we have as much time as we need for questions.

Alex: Maybe this isn’t relevant—

Dr. Dan: Any question you have is relevant. An important part of therapy is feeling safe, and safety for many people is rooted in understanding. So, please, ask away.

Alex: How did MDMA even become used for this kind of therapy? I mean, it was an illegal drug when I took it in college, right?

Dr. Dan: "The history of MDMA is really interesting. It was discovered in 1912 by a chemist working for Merck, but no one really understood how it worked until a man named Alexander Shulgin, a chemist working for Dow at the time, independently synthesized it in 1965.

"Shulgin tested it on himself, thought it had promise, and gave it to a psychotherapist friend of his named Leo Zeff. Zeff realized it had great potential as an aide for psychotherapy, because it lowered people’s inhibitions and gave them a deeper access to themselves.

In the ’70s and ’80s, Zeff went on to travel the world and trained thousands of therapists on how to use this compound in their therapy, to great effect.

Alex: Oh wow. If it started out being used in therapy, how did it become illegal?

Dr. Dan "Well, as this was going on, some other people started using MDMA as a party drug, and it came to be known as Ecstasy. It was caught up in the massive anti-drug campaigns of the ’80s and made a Schedule 1 drug, which means the federal government declared it had no medicinal purpose.

"That was very unfortunate because it clearly had medicinal use and was being used by thousands of psychotherapists, and many of the early studies were quite promising.

"After being put into Schedule 1, its use was super restricted, and essentially, it went underground.

"From there, an organization called MAPS spearheaded the effort to do double-blind, placebo-controlled trials to make MDMA legal again.

"The studies showed incredible promise, and after many years of effort, in 2017, MDMA was granted ‘breakthrough therapy’ designation for PTSD by the DEA.

After the astonishing results of the Phase 3 trials, it’s now legal to use with a prescription and in controlled settings like this one, of course.

Alex: I had no idea it’s been in use that long.

Dr. Dan: Most people don’t.

Alex: How does MDMA work, as a medicine?

Dr. Dan: "It’s the best compound we know for dealing with trauma because it does three primary things in the brain: First, it relaxes the fear center. Second, it helps you achieve heightened self-awareness in the observation part of the brain. Third, it improves your level of connection between the memory center in the hippocampus and the observation part of the brain.

"What all this means is that we’re able to be less guarded and more available to see the truth, and we have a better memory of when the truth got shut down. Once your brain gets into this state, then it’s able to bring up and feel deeply repressed and difficult emotions.

You create the space for the emotions; you allow them to come up; you process what you need to feel about them, learn from them, and then you’re able to let them go. Does that make sense?

Alex: Yeah, I think so. What will it feel like when I take it as part of therapy?

Dr. Dan: When you took Ecstasy in college, what did it feel like?

Alex: Pretty amazing. I felt good, I danced a lot, and I had this really blissful experience. I felt really terrible the next day though, so I never took it again.

Dr. Dan: How do you respond to caffeine and other stimulants?

Alex: Normally. Some more energy—that’s about it.

Dr. Dan: "Okay, good. MDMA usually feels like you drank a double espresso. Your heart rate and blood pressure will go up some. You’ll probably feel the sensation of warmth as it starts to come on. From there, it